Check this checkbox if you want to send me money: 

Enter your credit card number in this text box: 
Expiration date: 

Select the card type with these buttons:
 Visa
 Mastercard
 American Express

Choose the amount of your contribution from this list: 
 P12,000
 P10,000
 P6,000
 P5,500
 P3000
 P1500
 Whatever


 Pick your reason from this pull-down list: 
 Educational loan
 Post Check
 Financial problem
 Others


Promissory Note: please type